Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (&lt;40 years) women treated with breast conserving surgery first

Bollet, Marc A.; Sigal‐Zafrani, Brigitte; Mazeau, Valérie; Savignoni, Alexia; Rochefordière, Anne de la; Vincent‐Salomon, Anne; Salmon, Rémy; Campana, F.; Kirova, Youlia; Dendale, R.; Fourquet, A.

doi:10.1016/j.radonc.2007.01.001

Cited by 129 publications

(84 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Skin-sparing mastectomy was chosen over breast-conserving surgery in this patient to prevent radiotherapy during her pregnancy, as well as considering the higher local relapse rates after breast-conserving treatment in young women [3,4]. In younger women, 10-years risk of recurrence of 20% can be reduced to 10% by radiotherapy boost [5].…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of breast cancer is independent of the pregnancy, and termination of the pregnancy is not indicated [1]. Surgery is not contraindicated during the first trimester, but could be associated with low birth weight or premature labour [2].Skin-sparing mastectomy was chosen over breast-conserving surgery in this patient to prevent radiotherapy during her pregnancy, as well as considering the higher local relapse rates after breast-conserving treatment in young women [3,4]. In younger women, 10-years risk of recurrence of 20% can be reduced to 10% by radiotherapy boost [5].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Breast cancer and pregnancy: diagnosis and treatment options

Velde

Sonke

Rutgers

2009

Breast Cancer Online

View full text Add to dashboard Cite

A 36-year-old woman had noticed a lump in her right breast, just after she had discovered she had been pregnant for about 6 weeks. At referral to our clinic, on physical examination a palpable mass was found in the upper quadrant of her right breast, sized 2 cm in diameter.Diagnostic mammography and ultrasound were performed elsewhere and showed an uncertain density on mammography and an uncertain hypoechoic structure on ultrasound cranial to the righter mammilla, sized 15 mm in diameter. Utrasound of the axilla showed no suspected lymph nodes. A core biopsy proved an adenocarcinoma.After discussing the different options, the patient preferred a skin-sparing mastectomy with nipple banking and sentinel node biopsy. The sentinel node was retrieved by 85 MBq technetium-99m nanocolloid intra-tumoural injection, without using blue dye.At histopathology the tumour was T1 (15 mm) in size, B&R grade II; the sentinel node was tumournegative after multiple slicing and IHC staining with Cam 5.2; oestrogen receptor was 100% positive and progestin receptor was 100% positive; HER2-neu was negative. The margins were free. The Mammaprint s showed a low-risk signature, that is no distant metastases within at least 5 years.Since the patient was in her first trimester of pregnancy, and the child was very much desired, finally, the patient opted for endocrine therapy. She will receive tamoxifen and ovarian suppression by LHRH agonist after her child delivery. She decided not to have adjuvant chemotherapy, particularly considering the high hormone responsiveness of the tumour and the Mammaprint low risk. In addition, due to her young age, she was referred to the genetic counselling department. DiscussionBreast cancer is the second most common cancer in pregnant women. The prognosis of breast cancer is independent of the pregnancy, and termination of the pregnancy is not indicated [1]. Surgery is not contraindicated during the first trimester, but could be associated with low birth weight or premature labour [2].Skin-sparing mastectomy was chosen over breast-conserving surgery in this patient to prevent radiotherapy during her pregnancy, as well as considering the higher local relapse rates after breast-conserving treatment in young women [3,4]. In younger women, 10-years risk of recurrence of 20% can be reduced to 10% by radiotherapy boost [5]. However, older radiation courses showed to be dangerous to the foetus [6], and although no data exist on effects of modern radiotherapy, it is not advised in the first trimester until after delivery (Dutch guidelines: http://www.oncoline.nl).The sentinel node biopsy was performed using a lower dose of nanocolloid than usual. In a recent review, the axillary lymph node dissection is advocated as opposed to sentinel lymph node biopsy [7]. However, according to others, we believe that it can be performed safely [8,9], since -even with normal intra-tumoural dosage -the dose to the foetus is proven to be negligible [9]. We used a dose Correspondence to: E. J. Th. Rutgers, The

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Breast cancer and pregnancy: diagnosis and treatment options

Velde

Sonke

Rutgers

2009

Breast Cancer Online

View full text Add to dashboard Cite

show abstract

“…Out of a previously described series of 209 premenopausal women, younger than 40 years old, treated at the Institut Curie between 1985 and 1995 for early breast cancers (clinical T1-2, N0-1 ; Sobin and Wittekind, 2002) with primary breast-conserving surgery and followed over a long period (median follow-up of 12 years), 70 patients were diagnosed with local recurrences (Bollet et al, 2007). We consider here a group of 63 patients for whom histological and immuno-histochemical data were available for both the primary tumour and the local relapse (some patients were not treated for their local relapse at the Institut Curie).…”

Section: Methodsmentioning

confidence: 99%

“…British Journal of Cancer (2007) Breast-conserving treatments of early stage breast cancer exposes the patient to the risk of ipsilateral breast tumour recurrence (IBTR). The most important prognostic factor for local recurrence is the young age of the patient (Vrieling et al, 2003) and this remains true among young (o40 years old), premenopausal women treated either by surgery first (Bollet et al, 2007) or by neoadjuvant chemotherapy (Oh et al, 2006). Many questions remain unanswered concerning the real nature of these ipsilateral breast tumour recurrences.…”

mentioning

confidence: 99%

Are ipsilateral breast tumour invasive recurrences in young (⩽40 years) women more aggressive than their primary tumours?

Sigal‐Zafrani

Antoni

et al. 2007

Br J Cancer

View full text Add to dashboard Cite

The characteristics of ipsilateral breast tumour recurrences (IBTRs) relative to those of their primary tumours (PTs) remain scarcely studied. Of 70 young (p40 years) premenopausal women with IBTRs, we studied a series of 63 with paired histological data. Median follow-up since IBTR was 10 years. Rates of histological types, grades or hormonal receptors were not significantly different in PTs and in IBTRs. The concordance between IBTRs and their PTs was good for histological types. IBTRs with conserved histological types tended to occur more locally, but not significantly sooner than others. These IBTRs had good concordance for hormone receptors. In discordant cases there were as many losses as appearances of the receptors. The concordance was weak for grades, with equivalent numbers of IBTRs graded lower as higher than their PTs. The 10-year overall survival rate was 70%. Neither the conservation of histological type, location, nor of the two combined were associated with deaths. Early (o2 years) IBTRs, tended to be associated with poorer survival (HR ¼ 2.24 (0.92 -5.41); P ¼ 0.08). IBTRs did not display features of higher aggressiveness than PTs. Neither clinical nor histological definition of a true recurrence could be established other than the conservation of the histological type. British Journal of Cancer (2007) Breast-conserving treatments of early stage breast cancer exposes the patient to the risk of ipsilateral breast tumour recurrence (IBTR). The most important prognostic factor for local recurrence is the young age of the patient (Vrieling et al, 2003) and this remains true among young (o40 years old), premenopausal women treated either by surgery first (Bollet et al, 2007) or by neoadjuvant chemotherapy (Oh et al, 2006). Many questions remain unanswered concerning the real nature of these ipsilateral breast tumour recurrences. We shall examine how different they are from primary tumours and whether there are clinical or histological factors to help distinguish between a re-growth of malignant cells not removed by surgery and not killed by radiotherapy (also called a true recurrence, TR) and a de novo malignancy arising from mammary epithelial cells of residual breast tissues (also known as new primary tumours, NP) (Haffty et al, 1993). Some have implied that ipsilateral breast tumour recurrences should display features of, at least as much aggressiveness (differentiation (Huang et al, 2002), ploidy (Haffty et al, 1993) and percentage of invasiveness (Haffty et al, 1993;Smith et al, 2000;Huang et al, 2002)) to qualify as true recurrences. We shall see whether biological evidence can be found to support this definition. Finally, we shall investigate whether the characteristics of ipsilateral breast tumour recurrences are associated with prognosis. PATIENTS AND METHODSOut of a previously described series of 209 premenopausal women, younger than 40 years old, treated at the Institut Curie between 1985 and 1995 for early breast cancers (clinical T1-2, N0-1 ; Sobin and Wittekind, 2002) with primary brea...

show abstract

“…It has been noticed that younger women have higher recurrence rates after BCS. 45,46 Since the source of our study was pathological records, patients' choices were not addressed although they could have influenced mastectomy rates. 22,28,35,47 Some authors have concluded that, even though the public health system pays for mammograms, the adherence of women to screening mammograms is still low in Brazil, especially among less privileged women.…”

Section: Frommentioning

confidence: 99%

Changes in mastectomy rates at a Brazilian public hospital over 20 years (1989 to 2008)

et al. 2012

View full text Add to dashboard Cite

CONTEXT AND OBJECTIVE: Recently, breast-conserving surgery (BCS) has been replacing mastectomy for breast cancer treatment. The aim of this study was to evaluate the changes in mastectomy and BCS rates and the factors relating to these shifts. A shift from mastectomy towards BCS was observed (P < 0.001). In multivariate analysis, earlier year of surgery (P < 0.001), larger tumor size (P < 0.001), having at least one positive axillary lymph node (P < 0.001) and patients' age greater than 68 years (P = 0.007) were predictors of mastectomy. CONCLUSIONS: There was a shift from mastectomy towards BCS in our institution over the years. This may reflect consolidation of BCS (plus radiotherapy) as an equivalent treatment to mastectomy in terms of survival and a shift to earlier diagnosis for the disease.RESUMO CONTEXTO E OBJETIVO: Recentemente, a cirurgia conservadora tem substituído a mastectomia para tratamento cirúrgico do câncer de mama. O objetivo deste estudo é avaliar as mudanças nas taxas de mastectomia e cirurgia conservadora e os fatores relacionados a essas mudanças. correspondentes a cirurgia conservadora. A cirurgia conservadora se tornou mais frequente ao longo dos anos (P < 0,001). Em análise multivariada, ano mais precoce da cirurgia (P < 0,001), maior tamanho tumoral (P < 0,001), ter ao menos um linfonodo axilar positivo (P < 0,001) e idade maior de 68 anos (P = 0,007) foram preditores de mastectomia. CONCLUSÕES: As cirurgias conservadoras se tornaram mais frequentes em relação às mastectomias ao longo dos anos. Isso pode refletir a consolidação da cirurgia conservadora (associada a radioterapia) como equivalente à mastectomia em termos de sobrevida, bem como diagnóstico mais precoce da doença.I MD, PhD Student. General Surgeon,

show abstract

Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (<40 years) women treated with breast conserving surgery first

Cited by 129 publications

References 51 publications

Breast cancer and pregnancy: diagnosis and treatment options

Breast cancer and pregnancy: diagnosis and treatment options

Are ipsilateral breast tumour invasive recurrences in young (⩽40 years) women more aggressive than their primary tumours?

Changes in mastectomy rates at a Brazilian public hospital over 20 years (1989 to 2008)

Contact Info

Product

Resources

About